TANYA'S

COMPREHENSIVE GUIDE TO

FELINE CHRONIC KIDNEY DISEASE

 
 

PREVENTION

 

ON THIS PAGE:


Could I Have Prevented It?


Which Steps to Take


 

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KEY ISSUES


Nausea, Vomiting, Appetite Loss and Excess Stomach Acid


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SYMPTOMS


Alphabetical List of Symptoms and Treatments


Fluid and Urinary  Imbalances (Dehydration, Overhydration and Urinary Issues)


Waste Product Regulation Imbalances (Vomiting, Appetite Loss, Excess Stomach Acid, Gastro-intestinal Problems, Mouth Ulcers Etc.)


Phosphorus and Calcium Imbalances


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DIAGNOSIS: WHAT DO ALL THE TEST RESULTS MEAN?


Blood Chemistry: Kidney Function, Potassium, Other Tests (ALT, Amylase, (Cholesterol, Etc.)


Calcium, Phosphorus, Parathyroid Hormone (PTH) and Secondary Hyperparathyroidism


Complete Blood Count (CBC): Red and White Blood Cells: Anaemia and Infection


Urinalysis (Urine Tests)


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Renomegaly (Enlarged Kidneys)


Which Tests to Have and Frequency of Testing


Factors that Affect Test Results


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TREATMENTS


Which Treatments are Essential


Fluid and Urinary Issues (Fluid Retention, Infections, Incontinence, Proteinuria)


Waste Product Regulation (Mouth Ulcers, GI Bleeding, Antioxidants, Adsorbents, Azodyl, Astro's CRF Oil)


Phosphorus, Calcium and Secondary Hyperparathyroidism (Calcitriol)


Miscellaneous Treatments: Stem Cell Transplants, ACE Inhibitors - Fortekor, Steroids, Kidney Transplants)


Antibiotics and Painkillers


Holistic Treatments (Including Slippery Elm Bark)


ESAs (Aranesp, Epogen etc.) for Severe Anaemia


General Health Issues in a CKD Cat: Fleas, Arthritis, Dementia, Vaccinations


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Working with Your Vet and Recordkeeping


 

DIET & NUTRITION


Nutritional Requirements of CKD Cats


The B Vitamins (Including Methylcobalamin)


What to Feed (and What to Avoid)


Persuading Your Cat to Eat


Food Data Tables


USA Canned Food Data


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USA Cat Food Manufacturers


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Home > Miscellaneous > Prevention

 


Overview


  • I hear quite regularly from people who are worried that they could have prevented their cat developing CKD but failed to do so.

  • In many cases, these people have just lost their cat and are overcome with grief and guilt; in other cases their cat has just been diagnosed and they too are feeling guilty.

  • Others have lost a cat and are now adopting a new cat, and are terrified at the thought of having to go through CKD again in the future.

  • In most cases you cannot prevent CKD. However, there are a few steps you can take to reduce the risks, which this page discusses.


Could I Have Prevented It?


 

I must say, we humans do have an amazing capacity to beat ourselves up. People worry about everything they did or didn't do. Many focus in particular on the foods they have been feeding, convinced that they made wrong choices.

 

Let me spell this out loud and clear: it is highly unlikely that anything you did or didn't do caused your cat to develop CKD. In truth, CKD is rarely avoidable, particularly in older cats - as the What Happens in CKD page mentions, around 10% of cats over the age of ten will develop CKD, with as many as 30% of cats over the age of 15 having the disease. The Causes of CKD page discusses the various causes in more detail.

 

On the one hand, this is reassuring. On the other hand, it means, of course, that this page is necessarily short, because it is not usually possible to prevent CKD.

 

We all know of people who eat healthily and exercise, only to drop dead at the age of 40. We all also know of people who eat whatever they like, smoke like chimneys, drink like a fish, and live to 98. It is the same with cats. Many factors determine a cat's fate, including luck. Some are dealt a better genetic hand than others. Pedigree cats tend to have shorter lives because of inbreeding; but if, like me, you like a particular breed, you may have to accept that as one of the risks you take.

 


Which Steps to Take


 

Having said all that, there are a few things you can do. These are the steps I would take to reduce the risks of CKD developing; though remember, there are no guarantees. Still, none of these steps is particularly onerous, and you will note the food suggestions are also not too gruesome - there is simply no evidence that diet plays that big a role in the development of CKD.

 

Ideally you want to implement all these steps when your cat is young. It is usually easier for cats to accept new routines when they are young, and it increases your chances of success. Still, implementing many of these even at a more advanced age can still be beneficial, for example cleaning your older cat's teeth regularly.


Regular Examinations                                                                                                              


 

Even if you don't have your cat vaccinated every year, you should still have your cat thoroughly checked over by your vet at regular intervals. See below for frequency of visits and which checks and tests to run. Doing this will not necessarily prevent CKD (though it may do so if, for example, you are able to nip a urinary tract infection in the bud before it rises into the kidneys and causes permanent damage), but it can help you detect it earlier so you can be proactive with treatments. It also enables you to establish a relationship with your vet.

 

Inbetween vet visits, be sure to monitor your cat at home for weight loss, food and water intake and changes in bladder or bowel habits or in coat condition. I recommend weighing your cat regularly (see scales) in order to spot any weight loss early, which may indicate CKD or other health problems such as hyperthyroidism.

 

Obviously if your cat seems ill between check ups, or you notice changes such as weight loss or reduced appetite, you should take your cat to the vet.

 

Younger Cats


All of my cats visit the vet for a check up at least once a year, no matter how old they are. The check up includes a physical examination and a dental check as a minimum. If the vet or I have any additional concerns, urinalysis and blood tests may also be run. If my cats are to undergo surgery for any reason, blood tests are run first.

 

Older Cats


Although occasionally younger cats get CKD, it tends to be a disease of the older cat. I therefore make it a rule that any of my cats who are aged between eight and ten have the following tests once a year:

  • a physical examination

  • urinalysis

  • a dental check

  • blood tests, including the new SDMA test, plus a test for hyperthyroidism

  • a blood pressure check

Once cats reach the age of ten, I would recommend checks every six months.

 

The American Association of Feline Practitioners provides guidelines on how to be proactive in caring for a senior cat. It recommends (page 3) that blood tests, urinalysis and a blood pressure check should be performed every year in cats starting between the ages of 7 and 11 with no clinical signs of disease.

 

Cornell University College of Veterinary Medicine has information on what to expect as a cat ages.

 

Antech Diagnostics discusses the results of a study at a Los Angeles veterinary hospital into the benefits of bloodwork and other tests performed in cats over the age of 7 who were apparently healthy.

 

Insurance


Starting young can be particularly beneficial if you wish your cat to have health insurance, because you will have few or no exclusions if your cat is young and healthy. Choose your insurer carefully: you want one which provides cover for life, rather than one which pays up the first year a problem arises but then excludes that problem thereafter, or one who pulls or reduces the cover massively once the cat reaches a certain age (which may be as young as eight).

 

If you don't insure your cat, it can be worth self-insuring if you can. This basically means you put money aside to pay for future vet bills. Some people believe this is better value than insurance.

 

Body Condition


It is important to monitor your cat's weight. Weight loss in older cats is not good news.  Effect of diet and body composition on lifespan in aging cats (2010) Cupp CJ and Kerr WW Presentation to the 2010 Nestle Purina Companion Animal Nutrition Summit found that "aging cats that lose excess body weight and body condition (fat or lean) have a significantly greater risk for earlier mortality." Therefore I would not put your older cat on a diet. If your cat is getting thin, try to get weight on. Low protein foods are not a good idea for healthy cats (see below). Determining protein requirements: nitrogen balance versus lean body mass (2013) Laflamme DP Nestlé Purina Companion Animal Nutrition Summit Tackling Myths About Pet Nutrition pp42-45 states "Previous research suggests that unexplained weight loss, especially in geriatric cats, can be the first sign of an impending terminal condition." Effect of nutritional interventions on longevity in senior cats (2007) Cupp CJ, Jean-Philippe C, Kerr WW, Patil AR & Perez-Camargo G The International Journal of Applied Research in Veterinary Medicine 5(3) says "there is evidence that extreme leanness in old cats may actually be detrimental. Emaciated cats had a significantly higher risk of death compared with cats in optimal body condition. Perez-Camargo et al demonstrated that body weight, lean body mass, and fat mass decline in cats over the age of 12 years, particularly in the last 1 to 2 years of life."

 

Skinny old cats: why some senior cats lose weight. What's going on? (2014) Williams D DVM360 Magazine states that the last study mentioned above found that "a control diet (nutritionally complete and balanced adult cat food) supplemented with antioxidants (vitamin E and β-carotene), a blend of n-3 and n-6 fatty acids, and a prebiotic (dried chicory root) was associated with reduced decline in body weight and increased longevity (by more than 1 year) compared with feeding either the control diet alone or the control diet supplemented with antioxidants alone. These striking observations illustrate the potential benefit to be gained from dietary and other interventions to address the gastrointestinal changes that appear to be so common in aging cats."

 

See Nutritional Requirements for more information on weight and muscle in cats.

 

Purina has a Body Condition diagram showing how to gauge your cat's physical condition.

 


Avoid Toxins


 

Since cats are unique physiologically, there is a whole host of items which they should avoid. Antifreeze and lilies can kill a cat. There is more information here. I never allow lilies in my home for this reason, they go straight in the bin should anybody happen to bring me any. 

 

Most non-steroidal anti-inflammatory medications are a problem for cats, who can only metabolise them very slowly. In some cases, kidney damage may result. If your otherwise healthy cat needs to use meloxicam (Metacam) for some reason, the dosage used is crucial. Please see Treatments for more information.

 

A surprising number of foods are bad for cats. Grapes and raisins may damage the kidneys. Garlic and onion can cause anaemia. Fish can be a problem if you feed nothing else, even if you are feeding a commercial fish-based food. The Merck Veterinary Manual states that "there are reports of commercial cat food causing severe neurologic disturbances in cats fed an exclusive tuna diet for 7-11 months." Pet Education has a list of foods to avoid.

 


Infections and Inflammation


 

Treat infections promptly, particularly urinary tract infections, which may rise into the kidneys and cause permanent damage.

 


Dental Problems


Take particular care of your cat's oral health. Most cats develop dental problems by a young age, 3 or 4. The Cat Doctors state that "Dental disease doesn’t affect just the mouth. It can lead to more serious health problems including heart, lung and kidney disease."

 

Learn how to use a feline toothbrush and clean your cat's teeth regularly. If a dental procedure nevertheless becomes necessary, have it performed promptly. See Dental Problems for more information on feline toothbrushes and precautions during dental procedures.

 


Vaccinations


I am in two minds about vaccinations. If you have ever had a cat develop cat flu (feline herpes virus), as I have, you know it is worth avoiding, and vaccinations can help with this. On the other hand, there is some indication that there may be a link between vaccination and CKD.

 

If you are in the USA, the protocol is that the standard vaccinations now only need to be given every three years, which provides adequate protection but may reduce the risks. The frequency for rabies varies, depending upon the vaccine used.

 

For what it is worth, I do vaccinate my own cats, at least until they are twelve years old.

 

Please read the Causes of CKD and Treatments pages for more information.

 


Dietary Issues


 

Diet is a tricky area, because feline nutritional needs are complex. Although some people have strong opinions about which are the best foods for cats, unfortunately, there is no firm evidence in many areas.

 

There is no perfect food out there, so just do the best you can. Please also read the Nutritional Requirements and Which Foods to Feed pages, and above all, make sure your cat eats.

What to Feed


 

Antioxidants and Essential Fatty Acids


In one study, Effect of nutritional interventions on longevity in senior cats (2007) Cupp CJ, Jean-Philippe C, Kerr WW, Patil AR & Perez-Camargo G The International Journal of Applied Research in Veterinary Medicine 5(3), healthy older cats fed a diet containing antioxidants including additional essential fatty acids lived significantly longer.

 

Effect of diet and body composition on lifespan in aging cats (2010) Cupp CJ and Kerr WW Presentation to the 2010 Nestle Purina Companion Animal Nutrition Summit discusses this study. It found that a diet which included antioxidants, essential fatty acids and a prebiotic appeared to extend the lives of the cats in the study, who were aged between 7-17 (go to page 44). Cats fed a diet with these added supplements lived 1.3 years longer than cats fed a complete adult cat food.

 

Wet (Canned) Food


Many people are evangelical about this. Some of them go so far as to claim that feeding dry food only may actually cause CKD, although there is no evidence of this.

 

I certainly am not opposed to feeding wet food, but unfortunately it is not always as ideal or simple as it first appears - see Which Foods to Feed for more information.

 

A possible compromise is to do as I do and feed a mixture of wet and dry food.

 

Low Phosphorus


Phosphorus is a problem for CKD cats because their kidneys cannot excrete it efficiently, so it builds up in their bodies. Healthy cats should be able to excrete phosphorus, so in principle there is no reason to feed a reduced phosphorus diet to healthy cats. If you do, it is possible that phosphorus levels might reduce too far (below 3 in US values in bloodwork), which can cause weakness and lethargy.

 

Personally, I would not be at all concerned about the phosphorus levels in a food for a younger cat - kittens in particular, who are still growing, need phosphorus in order to build healthy bones.

 

Having said that, since CKD cannot be detected until at least 66% of kidney function is already gone (though the new SDMA test may change this), it may be worth considering feeding lower phosphorus foods to an older cat (over ten years of age). Discuss this with your vet. Prescription kidney diets tend to have a phosphorus level of around 0.5-0.7% on a dry matter analysis basis. Any commercial food in the USA which is labelled as a complete adult maintenance diet will have a minimum phosphorus level of 0.5% on a dry matter analysis basis. I would aim to feed a food with a phosphorus level of 0.5-1.0% on a dry matter analysis basis; but remember, the most important thing is that a cat eats. You can check the phosphorus levels in various foods here.

 

Lenziaren


A new phosphorus binder for cats called Lenziaren (also known as SBR759) was introduced in Japan and Taiwan since 2013  and presumably Novartis, the manufacturer, will be releasing it in other markets in due course.

 

Unlike other phosphorus binders, according to Scientific opinion on the safety and efficacy of Lenziaren (iron, aqua carbonate hydroxyl oxo starch sucrose complex) as a feed additive for cats (2013) Panel on Additives and Products or Substances used in Animal Feed European Food Safety Authority Journal 11(5) p3204-5, Lenziaren is "intended to be used in food for adult cats to reduce phosphate absorption in the gastrointestinal tract in order to prevent chronic kidney disease." However, although Efficacy and acceptability of the new oral phosphate binder Lenziaren in healthy cats fed a renal diet (2015) King JN, Delport PC, Luus HG, Erasmus HL, Barnes PM & Speranza C Journal of Veterinary Pharmacology and Therapeutics 38(3) pp278–289 found that Lenziaren seemed to be well tolerated when added to food, it also found that when healthy cats were given higher doses of Lenziaren, their phosphorus levels actually increased. The manufacturer is currently investigating this.

 

Scientific opinion on the safety and efficacy of Lenziaren (iron, aqua carbonate hydroxyl oxo starch sucrose complex) as a feed additive for cats (2013) Panel on Additives and Products or Substances used in Animal Feed European Food Safety Authority Journal 11(5) p3204-5 states "the FEEDAP Panel has some reservations regarding the value of its long-term use in healthy cats. The Panel concludes that there is a need for a post-market monitoring plan."

 

Personally, I think I would rather feed a lower phosphorus food first.

 

Free Feeding


A 2002 study, Diet and lifestyle variables as risk factors for chronic renal failure in pet cats (2002) Hughes KL, Slater MR, Geller S, Burkholder WJ, Fitzgerald C Preventive Veterinary Medicine 55(1) pp1-15, compared cats in three groups:

  • free feeding with fibre;

  • free feeding with Factor-2 (a composite variable composed of fiber, magnesium, protein, sodium and ash);

  • and fibre alone.

The researchers concluded that free feeding was associated with increased odds of developing CKD. However, they did not simply free feed the cats; they also gave them additives. It is therefore not known whether free feeding alone would give similar results.

 

I myself have always free fed, and will continue to do so. In the wild, cats naturally feed multiple times a day. See Nutritional Requirements for more information on this topic.

 

High Quality Foods


This is another hot potato. Many people appear to be obsessed with feeding high quality foods, particularly high quality protein. What is high quality protein for a CKD cat does not mean what you probably think it means (see Nutritional Requirements).

 

What is high quality food for a healthy cat is debatable. Many people buy "premium", "high grade" foods, but what does that mean exactly? Why do so many of this type of food contain fruits and vegetables which cats do not need? Many people hate corn in foods, yet corn gluten meal is actually a protein that is almost as bioavailable to cats as chicken.

 

Please read the Nutritional Requirements page for more information on a cat's physiological needs and Which Foods to Feed for more information on commercial foods. Although these pages are geared towards a CKD cat, they do contain some information on feline nutritional needs generally.

 

What Not to Feed


 

Reduced Protein


I hear from people who have recently lost a cat and who want to try to ensure their remaining cats do not develop CKD. They have heard that a reduced protein intake may help CKD cats, so they sometimes are considering feeding therapeutic kidney diets to their other cats in the hope that feeding such foods may also prevent CKD.

 

I do not recommend this, because not only it is not going to help, but may even may cause problems. Healthy cats have a requirement for relatively high amounts of protein (see Nutritional Requirements). In fact, it is commonly recommended that even cats who already have CKD should not have protein restricted in the early stages of CKD. I would therefore not recommend feeding a low protein diet to a non-CKD cat, because it may eventually lead to malnutrition. In Nutritional management of renal disease (2008) Presentation to the World Small Animal Veterinary Association World Congress Dr K Sturgess states "From studies performed in dogs and cats, it can be concluded that there is no evidence in these species to suggest feeding high protein diets to normal animals is harmful."

 

Excess Vitamin D


Cats cannot manufacture Vitamin D so must obtain it from their food. However, many commercial foods seem to contain levels in excess of current maximum US allowances (10,000 iu/kg for adult cats). Update on the etiology of tooth resorption in domestic cats (2005) Reiter AM, Lewis JR & Okuda A Veterinary Clinics Small Animal Practice 35 pp913-942 states "results of experimental studies on cats fed diets high in vitamin D3 (15,000–33,840 IU/kg of dry matter) were contradictory, ranging from no evidence of detrimental effects on feline health to a high prevalence of renal dysfunction and mortality."

 

A 2013 study, Vitamin D intoxication caused by ingestion of commercial cat food in three kittens (2013) Wehner A, Katzenberger J, Groth A, Dorsch R, Koelle P, Hartmann K, Weber K Journal of Feline Medicine & Surgery 15(8) reported on three kittens in Germany who became ill after eating a commercial food containing too much Vitamin D. One recovered, one was put to sleep, the third has ongoing kidney damage. The commercial food in question was Almo Nature Kitten with Chicken food. It had a declared amount of Vitamin D3 of 6488 IU/kg (dry matter) but analysis showed that the food actually contained 202,155 IU/kg (dry matter).

 

It might be wise to feed a food that does not exceed the vitamin D guidelines.

 

Acidified Diets


Many commercial diets over the last ten years have been reformulated to promote "urinary tract health", or words to that effect. Essentially, these diets are acidified, so as to reduce the risk of cats developing feline lower urinary tract disease (FLUTD). Cats with FLUTD tend to have urine that is too alkaline, and are therefore at risk of developing struvite crystals, which develop in an alkaline environment. Feeding an acidified diet reduces this risk.

 

Unfortunately, feeding these diets to cats who are not at risk of FLUTD may lead to urine that is too acidic. It is speculated that acidified diets may be a factor in the increase in renal calculi (kidney stones) i.e. calcium oxalate stones, which develop in an overly acidic environment, and which in turn are a risk factor for developing CKD. These stones, unlike struvite, cannot be dissolved by diet - they can only be removed by surgery.

 

Acidified diets may also contribute to low potassium levels (see below).

 

 

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This page last updated: 24 April 2016

Links on this page last checked: 10 August 2015